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Home My WebLink AboutBuilding Permit #569-13 - 1500 Forest Street 2/21/2013 i NORT#1 BUILDING PERMIT o�tT�ao ,esti TOWN OF NORTH ANDOVER w APPLICATION FOR PLAN � � EXAMIN_A iI'�N Permit NO: Date Received `e q^T!D � Date Issued: 9SSACHus�� IMPORTANT:Applicant must complete all items on this page LOCATION for..�� Print PROPERTY OWNER P_!aQK e� VVVCVIA� Print MAP NO: PARCEL:UM ZONING DISTRICT: Historic District yes nn Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial _sAIteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition 0 Other 0 Septic ❑Well ❑ Floodplain 0 Wetlands 0 Watershed District ❑ Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: M'E�\1'�e�� ^A2�•� Phone: (P Address: I CONTRACTOR Name: Phone: Address: 1 Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. j FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 00 Total Project Cost: Gt7 FEE: $ �® 7' '► Check No.: Z�Q,c Receipt No.: P 4,; NOTE: Persons contracting with unregistered contractors do not have access to thearan fund Signature ofAgent/Owner Signature of contractor Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ • Foundation Permit Fee $ Other Permit Fee $ TOTAL $ • Check# 42 _ 26168 V Buildiflg Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Tow, Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMFNf =.Temp Dumpster on siteyes no Located atI24,Main"Street .;.. Fire Ddp6rt.i fent signature/da`te " 8 COMMENT .'" Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. I + Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No } MGL Chapter 166 Section 21A—F and G Min.$100-$1000 fine I NOTES and DATA— For department use i I 'I 1 �I t l ® Notified for pickup - Date it Doc.Building Permit Revised 2010 r i Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit. o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Li Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm:ated with the building application Doc: Doc.Building Permit Revised 2012 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA. 02111 ,Y www.mass.gov/Zia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name(Business/Organizatiordlndividual): ` � to M � Address: City/State/Zip: --�Ay�u� {V��_ (,2 j. Phone#: - i kre you an employer?Check the appropriate box: Type of project(required): ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction eirnloyees(full and/or part-time).* have hired the sub-contractors �am a sole proprietor or partner- listed on the attached sheet. 7 remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions El I am a homeowner doing all work right of exemption per MGL ME]ME]Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.] employees. [No workers' 13.❑Other comp.insurance required.] iy applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. )meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. ,n iin employer that is providing workers'compensation insurance for my employees. Below is the policy and job site grmation. urance Company Name: icy#or Self-ins.Lid.#: Expiration Date: Site Address: roa� � - City/State/Zip: ach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). lure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine ip to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of astigations of the DIA for insurance coverage verification. P hereby cert acnrler ns an penalties ofperjury that the information provided above is trite and correct. iature: Date: a- ne#: )fficial use only. Do not write in this area,to be completed by city or town official. :ity or Town: Permit/License# ssuing Authority(circle one): .Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Other '.nnfarf PPrenn• PhnnP#- Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, 3lease do not hesitate to give us a call. 'he Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 021.11 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE r.�_..__u tern r7nn r 17Ar% Massachusetts- Departnient of Public Sit#eta Board d of Building Rc ,ul itions and Standard's .. ✓;"t r�,.w k§xk)-"`orifi".IV License: CS 94632 _-_._. . . _....... _ STEVE A SWEENEY 199 CURTIS MILL LN q HANOVER, MA 02339 i - --—s Expiration: 10/4/2013 A [=,i�:iaiissi>ncr Tri?: 7047 ��e`Ea��zr�z��uoecr�/�c�C?i��cr:;:tcrc�ccsell' Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR egistrat�on: 161727 Type: xpirat on 1 U1$/20:t4 LLC KAKS HOME IMPROVEMENT SERVICES STEVEN SWEENEY 191 CURTIS MILL LN /J HANOVER,MA 02339 Undersecretary I I UIII. I IV i 19UIIVV1\ IIva U01cVICUIC IC.40 1riul f.VUi/VVI ZY CERTIFICATE OF LIABILITY INSURANCE ��`�°'°°f'"iZ THS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSMTUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTAIIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions ofthe policy,certain policies may require an endorsement A statement onthis certificate does not confer rights to the certificate holder in lieu of such end orselnerig* PRODUCER CONTACT NAW: Carol McHugh Twinbrook Insurance Brokerage PHONE {781} 843-7000 FAX N E?811 848-61b0 400A rranklin Street EMAIL, CM hu h@twinbrook.Cam Braintree, MA 02184 ADDRESS. _ INSUREFg3 AFPORDItT COVERAGE NAIC9 INWRERA:Travelers Insurance 08LRED INSURER B KMS Sete Impzovement Services INWRERC: 108 Ralph Talbot St IrvsuRERo: Vftymonth, MA 02190 INSURERE: It5UR8R F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERGA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOM MAY HAVE BEEN REDUCED BY PAID CLAMS. AML L TYPE OffNSNRANCt INSSR yWp POUCYNIMER APAL F fumu➢�t1fY�f'Y) UMTS A GENERALLwRTUTY 26805926X320ACJ11 3/24/12 3/24/13 EACHUCCURRENCE s 1,000,000 X COWERCK GENERAL LIABILITY llWrtaG TO RENTED;ESIED Cal $ 300,000 CLAWS{BALE ®OCCUR AED E)P"jormi person) $ 51000 _ PERSONAL&ADVIKIIRY $ 1,000,000 GEMERALAGGREGATE $ 2 .000,000 GENTAGGREGATELMT APPUESPER: PRODUCTS-COMP90PAGG $ 2,000,000 7X POLKY PRO LOC E AUTOMOBREUAIIiLnY (Es=0 SWGLELR11r S ANYAUTO BODILYINURY(Per poison) $ ALL01%ED SCHEDULED A003 AUTOS BODILYAI fN INJURY(Per axidard) $ NO"VMED _ PO ePmdTY HIREDA(TOS tS $ $ UMNIELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAS CIAA S-Mk E AGGREGATE 5 DED RETENTION WORKERS COMPENSATION I VYC STATU- I OTH- AND EMPLOYERS'LIABILITY YIN FR —" ANY PROFRIETURPfRTTERIE)ECUTNE EL.EACH ACOi£Mr OFFICE RIIENMER EXCLUDIEW �.N I A tMandato/Y In NH) E.L.DISEASE-ES EMPLOY S Xyesdesm lm br LFSCRFTI0 CF0PERATi0NStetotY EL.DISEASE-POLICYLIMIT I DESCRIPTIONOFOPERATIONSILOCATIMIVEWLES(AttahACORD10t,AditonalRenuftScImMe,l7muespace ismgtjled) CERTIFICATE HOLDER CANCELLATION Kaks Xc me Improvement Services SHOULDANY OF THE ABOVE DESCRIBED POLICES SE CANCELLED BEFORE THE EXPIRATION DATE TFErEOF, NOTICE WILL BE DELIVERED 'N 108 Ralph Talbot St ACCOROMCEV417H THE POLICY PROVISIONS. Weymouth, MA 02190 AUTFORM REPRESENTATIVE Joseph Rizzo O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: r- 1. NO R T!y _ . w: 1 I, : :. .� ve" 'o O No. 't h ver, Mass, �l / COC NIC NE WICK V ASR'4TED S U BOARD OF HEALTH P.. ERMI..T T LD Food/Kitchen Septic System j BUILDING INSPECTOR THISCERTIFIES THAT ........................... '................................:......................................................... Foundation has permission to erect.......................... buildings on ................................. to be occupied as s CS t �. .�59„)r! ............... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final p p p 9 on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. c Final PERMIT EXPIRES IN6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough Service ......... .. ................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buil Rough Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 48,916.00 m $ - $ 586.99 Plumbing Fee $ 73.37 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 73.37 Total fees collected $ 833.74 1500 Forest St. Ext. 569-13 on 2/21/13 Finish Basement IMPRESSIVE MINE MEN loom . 0■■ loom MEN■ ® ■ ■■1■■ ■ ■■■■■■■■ii'■r �■■�■■■■� ■ • �1■e ■■■■■■■■el■. ■■ ■■■■■ ■■■��■e ■ ■ ■ ■■l■ ITT, ■■ ■■E■■�i i�� ■e ■ ■e®��► ®® ■■� ■ ■■■■■es . ■■ ■�■C■■� Rol ■■■■i No M Mill ■....�1. � . f .. ■ .... ■■�®® . .. ■[■...■■ ■ ■E C7��1��1 ■ ■ ■■■1' ■■■■■ I■■■ .■ . �Il?�r71■.■. ■■■f� �i�!■!�!■■ !■■■ .■Cle■■■ !C■t ; SCO■ I■ . �!■ ■■■■■■■I■■■■■!!C\[�C■■NNE m E�■■■■■ i■ ■■I ■■■■!�®■!�■ ClwN 1I■■■ ■■■■.■�IC..�■■■■■■ ■1 ■■®1 1■■■ : .■■■moll■■■■1■■■■■■■EElm M! ;®■■■■bo■■�■■■ . FRP .. . • ... LING DROP LN LIFT CUSTOMER ADDRESS CITY' STATE��ZIP HOME PHONE - - 7, CEL PHONE 3 S5!0-c t?rS 5 6 7 8 9 10 11 12 13 14 15 16 17 8 19 20 1 2 23 24 25 26 27 28 29 30 3 4 5 6 t• r Iss 7 8 9 - 1 111 — 12 — 13 9 N 14 15 1 I 1 16 1 I I I � f _ 8 a _ 17' . 1 C7 _4 -- 19 20 21 a r- 22 22 f } 23 - fD 24 u 25 26 - 27 28 2940 30 31 32 ( -- 33 r 35 36 — 37 38 r 39 40 Lia WALLS ROX LN FT _COLO OR FlNISHE IM COLP ED WHITOAK P 2ND SIDE APPROX LN FT _FSK FRUTLETS ADD BREAKERS `. Q STANDARD DOORS 3(r-32'—!v ;WITCHES ADDSUB PANEL C BIFOLD DOORS 30' 38'^ W_60'_7Y GAN LIGHTS _�_ ELECTRICAL MOVES LU CEILING APPROX SO FT6% X4 LIGHTS #OF POLE WRAPS CEILING CEILING TILE SIZE Cl#ILING F HEATT OP LN LIT fi PPROX SOFT CARPET STAIRS_PAD REMARKS _ ! — W _ ` - a ! Wo RE CL RE NATURE HOME OWNER SIGNATOR H N 7I 1 IMPRESSIVE BASEMENT SYSTEMSTM KAKS Home Improvement Services,LLC 121 Hancock Street.Braintree,NIA 02184.Telephone 781-812-0236.E-Mail kakshis@comcast.net Contract between Home Owner and Contractor Home Owner paC�/ VQ(SContractor Name: Wwi I��KAKS Home Improvement Services,LLC Address: N )121)121 Hancock Street U City: State: MaZip:_11Z' (A A Braintree,NLA, 02184 Location o Proiect 781-812-0236 Address: 4B , Business ID: 000988900 City: i� State: Zip: Telephone: The Owner and Contractor a ree as set forth below: 1. Agreement Date: —""2. Contract Sum: ,Deposit at time of signin 3. Payment schedule: � � 1 ��113 Balance ofdue at completion. 4. Source of Funds: 5. DFAULT IN PAYMENT UPON COMPLETION: If I fail to pay the full amount of the UNPAID BALANCE OF CASH PRICE at the time the work is completed,you shall send this Contract and my obligations to your attorney for collection and enforcement for action and collection. If you do so,and only if permitted by applicable state law,l agree to pay,in addition to all other sums due under this Contract and only which may be collected in accordance with applicable state lawreasonable attorney's fees in an amount not exceeding FIF'T'EEN"15"PERCENT of the unpaid amount then owing,and court costs and fees incurred by you and enforcing this Contract. ZV6. COMPLETION SCHEDULE: Work will begin days after financing has been secured and completed no more than 21 days after start date. Contractor is not responsible for delays due to a change in the scope of work,material shortages and other factors out of his control such as weather,labor strikes,utility failures and inspectors. 7. SCOPE OF WORK: Finish basement with the"Impressive Basement and Wall Systems"including ceilings,electrical,doors and trims per attach drawings. 8. WORK TO BE EXCLUDED: No painting or staining will_be done by contractor. A1Zwood will be primed and re for a finished coat for responsibility for the customer to complete. Also excluded: 9" ARBITRATION: In the event any dispute shall arise between the parties to this Contract as to the respective duties,rights and liabilities there under,it is hereby agreed that such disputes shall be referred to the Better Business Bureau,Inc.for arbitratie3, and the decision of the arbitrators shall be final and binding on said parties. Verbal understandings and agreements with the representative shall not be binding. 10: COMPANY APPROVAL: This Contract is the subject to written approval by an officer of the Contractor Company. Said written approval will not be necessary if work is actually commenced by the Contractor. 11. WARRANTY: 10 year limited warrantyon material and labor due to factory defects and/or improper installation. 12. GENERAL PROVISIONS: Contractor is to include all labor and material to complete the scope of work. Contractor will leave premises broom clean- All work will be completed in a workmanship manner and in compliance with all codes and applicable laws. Any and all changes to the scope of work must be in writing. Any delay of payment will be subjected to the maximum interests and penalties allowed by law. The contractor has the right under Massachusetts Lien Laws to use your home as security for payment for this agreement. 13. It is the Owners responsibility to remove items before installation. If,however,this is done by the Contractor,the contractor assumes no liability for any damage or malfunction of any item. 14. Under Federal and State Law you have up to Thrcee""3^"business days to cancel this agreement. 15. Addendum s r R CK &—K' l a Owner must have area cleaned and clear of any and all personal items. Owner: �� (�j+ Contractor• By: Date: 4 3 By: Date: Print Name IVIPrint Name: „r,c_ w.�•4 Title